What is migraine?
Migraine is characterised by the sudden recurrence of a severe headache, which is often on just one side of the head. Theses intense headaches are accompanied by systemic distress, including nausea and vomiting, diarrhoea, faintness, chills, sweating, marked lethargy, and a desire to avoid light and sound.
Migraine headaches affect approximately 8% of the population. The pain is often severe enough to hamper daily activities and may last from four hours to three days, if left untreated.
Problems often begin during childhood, with initial episodes occurring prior to age 15 years of age, in approximately 50% of migraine patients. Similar headaches are commonly reported in blood relatives suggesting a genetic contribution to the disease. Women are two times more likely to suffer with migraine compared with men.
The way a migraine resolves varies greatly from person to person and can even differ for each episode. Most people get relief through sleep. Vomiting can make a person feel much better afterwards, in particular children. For a few, nothing works except letting the headache burn out.
Lethargy and a feeling of being completely drained of energy may last for about 24 hours after the migraine resolves. Some people feel energetic or even euphoric, once a migraine resolves.
Signs and symptoms of migraine
Approximately one in three people who get migraine experience warning symptoms called aura, which last on average one hour. A ‘classic’ migraine is accompanied by aura, but a ‘common’ migraine is not.
Typical aura symptoms:
- Visual disturbance – flashing lights, zigzag sight, double vision, temporary loss of vision
- Paresthesia – numb or prickling sensation (pins and needles) in the face, hands, arms
- Difficulty speaking, slurred speech
- Inability to concentrate
- Uncoordinated movement.
Migraine can occur at any time. Occasionally a person will sense a migraine is imminent. These sensations are different to aura and may include irritability, inability to concentrate, food cravings, and fatigue.
- Headache (moderate to severe) that lasts from four hours up to 72 hours
- Pulsating, throbbing head pain, often on just one side of the head
- Nausea or vomiting
- Increased sensitivity to light and noise
- Headache that may ease with bed rest.
A person with these symptoms should see a doctor when:
- Migraines become worse or more frequent
- Person more than 50 years of age when migraines start
- Aura symptoms last more than one hour
- Migraine lasts more than 72 hours.
Conventional medical treatment for migraine
A classic migraine follows a set of warning symptoms collectively called aura. Migraine with aura is a migraine preceded or accompanied by flashes of light or blind spots, or by tingling in the hands or face. Foods, stress, and hormones can trigger a migraine. Women are particularly susceptible to migraine, because of hormonal fluctuations.
The throbbing pain typically occurs on one side near the temples, forehead, and eyes. Migraines can make a person extremely sensitive to light, sound, or physical exertion. Nausea, vomiting, or vision problems usually accompany migraine episodes. The pain can be so debilitating that the sufferer has to remain in bed, take time off from work, or miss out on other activities.
Migraine medication works best if treatment begins as soon as symptoms are noticed. Effective medication can significantly reduce the frequency, intensity, and length of migraines.
Several types of migraine medicines are prescribed to reduce intense pain:
- Beta-blockers – Inderal (propanalol) and Toprol (metoprolol), which relax blood vessels
- Calcium channel blockers – Cardizem (dilatizem) and verapamil, which reduce the amount of narrowing (constriction) of the blood vessels
- Antidepressants – amitriptyline and nortriptyline are tricyclic antidepressants effective in preventing migraines
- Anticonvulsants – Depakote (valproic acid) and Topamax (topiramate)
The FDA has approved Botox to treat chronic migraine, which is defined as “distinct and severe neurological disorder characterized by patients who have a history of migraine and suffer from headaches on 15 or more days per month with headaches lasting four hours a day or longer.” Botox is injected around the head and neck at 12-week intervals in an attempt to dull future headache symptoms.
Nutritional medicine treatment for migraine
As migraine is so variable regards causation and trigger factors, effective treatment requires careful assessment of nutritional and hormonal factors that may contribute to neuronal excitability and lowering of the hypothalamic threshold to ‘normal’ stimuli.
An integrated program is required to improve digestive capacity, balance food intake, stabilise neuronal membrane function, improve cell metabolism, reduce inflammatory mediators, enhance neurotransmitter balance, and stabilise hormone balance.
Nutritional treatment aims to improve digestive capacity, to ensure complete digestion of foods consumed, reduce activation of the gut associated lymphoid tissue (GALT), and prevent immuno-reactive oligopeptide formation.
Food nutrient intake needs to be balanced to control hypoglycaemia. Frequent smaller meals with only low-GI carbohydrates ensures a stustained supply of sugar for energy.
Food allergens and amine exposure need to be identified and removed from the diet. A person who suffers migraines must be screened for both IgE and IgG antibodies to foods.
High amine foods should also be excluded until migraine control is established. Biogenic amines are formed by the breakdown of dietary proteins. Usually the enzyme MAO renders amines harmless but if MAO levels are low or zero then amines build up in the body, causing aggression, bad behaviour in children, depression, migraines, and eczema.
Freshness is a key factor in avoiding amines as the amine content of foods varies with processing, age, ripeness, handling, storage, varietal, and cooking method. While the vacuum packing or meat, fruit, and vegetables can inhibit the growth of bacteria this does nothing to retard the development of amines. Cold tablets, decongestants, nasal drops or sprays, some pain relievers, general and local anaesthetics and some antidepressants contain amines.
Neuronal cell membrane function can be stabilised by balancing essential fatty acid and the calcium/magnesium ratio. Balancing the essential fatty acid ratio and correcting antioxidant capacity will minimise inflammatory mediator release.
Vitamins B6, B3, and zinc are required to optimise cell metabolism and neurotransmitter synthesis. Recent studies indicate that high-dose vitamin B2 also aids in migraine control.
Neurotransmitter precursors may be required, particularly tryptophan or 5-hydroxy-tryptophan, while DL-phenyl-alanine may be useful to increase brain opioid levels. Cholinergic agents, such as choline, phosphatidylcholine, and acetylcarnitine, may be useful in selected cases. Magnesium and dimethylglycine downregulate glutamate activation of NMDA receptor activity and may also be clinically beneficial.
Vitamins E, C, and B5 are essential to normal oestrogen synthesis, while pregnenelone may be useful in improving hormone production and the stabilisation of neuronal membrane activity. In menopausal and perimenopausal women, DHEA and progesterone supplementation are beneficial in improving hormonal status.